Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Dec 24;10(1):35-50.
doi: 10.1080/21556660.2020.1857149.

A systematic evidence-based review of treatments for primary hyperhidrosis

Michael E Stuart  1 , Sheri A Strite  1 , Kristin Khalaf Gillard  2
Affiliations

A systematic evidence-based review of treatments for primary hyperhidrosis

Michael E Stuart et al. J Drug Assess. .

Abstract

Objective: Hyperhidrosis (excessive sweating) is associated with significant quality-of-life burden yet is often undertreated. With limited FDA-approved treatments, health care providers must determine optimal treatment among approved and off-label options. Key objectives of this review were to reassess, update, and expand a previous systematic review of commonly used treatment options for primary hyperhidrosis, including consideration of aluminum and zirconium compounds.

Methods: We performed a qualitative systematic review of efficacy, health-related quality of life, satisfaction, and safety of interventions, replicating and expanding the strategy outlined in a previous systematic review, with the addition of studies utilizing a within-patient design. We performed a critical appraisal of identified studies to determine risk of bias (RoB) and strength of evidence (SOE).

Results: A total of 32 studies were eligible for critical appraisal. Only three studies - two clinical trials of glycopyrronium cloth (2.4%) and one trial of botulinum toxin A injections in axillary hyperhidrosis were rated as "low" RoB; both had SOE ratings of "moderate" for use in axillary hyperhidrosis - the highest rating included in this review.

Conclusions: Optimal treatment choice depends on several factors, including understanding the quality of evidence regarding each treatment's efficacy and safety (considerations of convenience and cost are beyond the scope of this review). In hyperhidrosis, as in other clinical conditions, treatment decisions should be patient centered. At this time, because of the quality of evidence, only imprecise estimates of effect are possible for hyperhidrosis treatments included in this review, and statements about comparative effectiveness are not possible.

Keywords: Hyperhidrosis; comparative effectiveness; evidence-based; strength of evidence; systematic review; within-patient study design.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Hyperhidrosis treatment options and sites evaluated.
Figure 2.
Figure 2.
Flowchart on methodology used for assigning RoB and SOE ratings.
Figure 3.
Figure 3.
Systematic review flowchart.
Figure 4.
Figure 4.
Overall summary of SOE ratings and evidence synthesis for unique studies identified for appraisal (n = 32)*.
See this image and copyright information in PMC

References

    1. Doolittle J, Walker P, Mills T, et al. Hyperhidrosis: an update on prevalence and severity in the United States. Arch Dermatol Res. 2016;308(10):743–749. - PMC - PubMed
    1. Glaser DA, Hebert A, Pieretti L, et al. Understanding patient experience with hyperhidrosis: a national survey of 1,985 patients. J Drugs Dermatol. 2018;17(4):392–396. - PubMed
    1. Hamm H, Naumann MK, Kowalski JW, et al. Primary focal hyperhidrosis: disease characteristics and functional impairment. Dermatology. 2006;212(4):343–353. - PubMed
    1. Naumann MK, Hamm H, Lowe NJ.. Effect of botulinum toxin type A on quality of life measures in patients with excessive axillary sweating: a randomized controlled trial. Br J Dermatol. 2002;147(6):1218–1226. - PubMed
    1. Kamudoni P, Mueller B, Halford J, et al. The impact of hyperhidrosis on patients’ daily life and quality of life: a qualitative investigation. Health Qual Life Outcomes. 2017;15(1):121. - PMC - PubMed

LinkOut - more resources